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Emergency Medicine Assistantship > Renal Emergencies > Flashcards

Renal Emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is AKI?

A

Sudden loss of kidney function causing hyperuraemia, and retention of other nitrogenous waste products, and dysregulation of extracellular volume and electrolytes.

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2
Q

What are the 3 classes of causes of AKI?

A

Pre-renal
Renal
Post-renal

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3
Q

How is AKI often detected and monitored?

A

Seriel serum creatinine readings
Urine output
eGFR

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4
Q

What are the main pre-renal causes of AKI?

A
  • Hypovolaemia - mainly sepsis or fluid depletion (vomiting/diarrhoea), anaphylaxis, cardiogenic shock
  • Oedematous states e.g. HF
  • CVS - HF, arrythmias
  • Hypoperfusion of kidneys e.g. by drugs, artery occlusion
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5
Q

Which drugs can cause AKI by renal hypoperfusion?

A

NSAIDs
COX-2 inhibitors
ACE-Inhibitors
ARBs

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6
Q

What are the main renal causes of AKI?

A
  • Glomerular disease
  • Tubular injury
  • Acute interstitial nephritis
  • Vasculitis
  • Eclampsia
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7
Q

What are the post renal causes of AKI?

A

Outflow obstruction due to:

  • Renal calculi
  • Blood clot
  • Urethral stricture
  • BPH/Ca Prostate
  • Bladder tumour
  • Pelvic fibrosis
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8
Q

How common is AKI?

A

~15% of adults admitted to hospital develop AKI (estimation)

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9
Q

Why is a good hx important when giving iodinated contrast agents?

A

Certain factors increase the risk of AKI following use to iodinated contrast agents.

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10
Q

Who is at higher risk of AKI following use of iodinated contrast?

A
  • CKD
  • Diabetes with CKD
  • HF
  • Age over 75
  • Hypovolaemia
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11
Q

What are the 2 cliinical features of AKI?

A
  • Oligouria/anuria

- Rise in serum creatinine

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12
Q

What rise in serum creatinine is indicative of AKI?

A
  • Rise of >26 nanomol/L in 48 hours

- >50% rise i.e. 1.5x baseline within last 7 days

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13
Q

A pt presents with AKI. They suddenly became anuric earlier today. Where is the cause most likely to be?

A

Outflow tract obstruction or renal artery occlusion

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14
Q

A pt with AKI is likely to be in fluid retention. What signs may there be of this on examination?

A
  • Hypertension
  • Raised JVP
  • Pulmonary oedmea
  • Peripheral oedma
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15
Q

Which antibiotics are nephrotoxic and therefore have the potential to cause AKI?

A

Aminoglycosides e.g. Gentamicin

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16
Q

A patient presents with haematuria. Where might the blood have originate from?

A 
Kidney
Ureters
Bladder
Urethra
Prostate
Vagina
17
Q

What are the different types of haematuria?

A

Visible and non-visible

18
Q

How might non-visible haematuria e picked up?

A

Either incidentally, or on dipstick following presentation with LUTS or upper UTS.

19
Q

Name the top 3 causes of non-visible haematuria.

A

UTI
BPH
Urinary calculi

20
Q

What features would be evident O/E of a patient with haematuria that would suggest a renal cause?

A

Hypertension
Altered renal funciton on Ix
Proteinura
Mass in renal angle

21
Q

Is anticoagulation likely to be the cause of haematuria?

A

No but it can provoke or worsen it.

22
Q

How should a patient with haematuria be investigated?

A

Exclude transient causes such as UTI.
Check U&Es and BP
Urine dip
Send urine for microscopy

All visible haematuria should be Ix to exclude malignancy

23
Q

What is an interstitial nephritis?

A

Renal failure associated with inflammation of the renal interstitium

24
Q

Which cells in the kidney have the endocrine function? What do they produce?

A

The interstitial fibrblast cells. They produce erythropoietin and prostaglandins.

25
Q

What are the 2 main forms of interstitial nephriitides?

A

Acute interstitial nephritis

Chronic tubulointerstitial nephritis

26
Q

What is the most common cause of acute interstitial nephritis?

A

Drugs/nephrotoxins.

27
Q

Which drugs are implicted in acute nephritis?

A

-Penicillins
-Cephlosporins
-Co-trimoxazole
Most abx tbh
NSAIDs
Loop and thiazide diuretics

28
Q

What is acute interstitial nephritis?

A

AKI/renal failure presenting in association with systemic infection, drug reaction, sarcoidosis, Sjogren’s syndrome or uveitis.

Emergency Medicine Assistantship (12 decks)

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